Management of Mild Asthma Exacerbation

Acute Exacerbation Management

The British Medical Journal recommends administering prednisone 30-40 mg daily by mouth until symptoms resolve and lung function returns to baseline, typically 7 days for mild exacerbations 1, 2
Oral administration is equally effective as intravenous steroids and is the preferred route, according to the British Medical Journal and the Journal of Allergy and Clinical Immunology 1, 2, 3
No tapering is required for courses under 2 weeks, as stated by the British Medical Journal 1, 2
The use of nebulized short-acting beta-agonist (albuterol) is recommended rather than metered-dose inhalers for patients who cannot cooperate with inhaler technique due to severe dementia, as suggested by the Journal of Allergy and Clinical Immunology 2, 3

Monitor oxygen saturation (maintain >90%), as recommended by the Journal of Allergy and Clinical Immunology 3
Assess respiratory rate, work of breathing, and ability to speak in full sentences, according to the Journal of Allergy and Clinical Immunology 4, 5
Clinical assessment may be more reliable than peak flow measurements for elderly patients, given cognitive limitations, as stated by the Journal of Allergy and Clinical Immunology 4

Monitor for corticosteroid side effects more closely in elderly patients, including hyperglycemia, hypertension, and gastrointestinal bleeding risk, as recommended by the British Medical Journal 1
The risk of GI bleeding is highest in patients with prior history or those on anticoagulants, according to the British Medical Journal 1

Consider oral theophylline as an alternative controller therapy option if nebulized corticosteroids are not feasible, though it requires careful monitoring for drug interactions and toxicity in elderly patients, as suggested by the British Medical Journal 2
Avoid doubling inhaled corticosteroid doses during exacerbations, as this strategy is ineffective, according to the Journal of Allergy and Clinical Immunology 5
Avoid over-the-counter cold remedies or antihistamines, which have no proven benefit and may cause confusion in elderly patients, as recommended by the Journal of Allergy and Clinical Immunology 5